With the aging of society and restructuring of families, it is increasingly important to understand how individuals become disabled. New disability is associated with increased mortality, substantial increases in medical costs (often borne by public payers), and a heavy burden on families and caregivers. While the disablement process-as theorized by Verburgge &Jette and their successors-has traditionally been seen as chronic and gradual, there is increasing recognition that acute events play a critical role in disability. Medical illnesses are not the only potentially disabling events. NIA &NINR recently posted PA-11-265, calling for """"""""Social and Behavioral Research on the Elderly in Disasters"""""""" in recognition that natural disasters are common, but we know little about their impact on health and disability. The National Research Council's Committee on Population published a report in 2009 documenting not only our ignorance in this area, but, importantly, the potential value of studying disasters to understand fundamental processes in disability and health. Our long-term research agenda is (a) to test the hypothesis that natural disasters cause enduring morbidity for survivors that is not fully addressed by existing health and welfare programs, and (b) to discover remediable mechanisms that generate that enduring morbidity. Here we propose a nationwide test of the association of living in a disaster area with individuals'long-term disability and heath care use. To perform this test, we will combine the unique longitudinal resources of over 16,000 respondents in the linked Health and Retirement Study (HRS) / Medicare files with a newly constructed mapping of all FEMA disaster declarations between 1998 and 2012. We will address key gaps in the existing literature of detailed single- disaster studies with a generalizable perspective across time and space via these Specific Aims: AIM 1 : Quantify the association between the characteristics of a disaster-measured as the type of disaster, the repair cost to public infrastructure, and duration of recovery-and increases in level of disabilit among survivors, for 5 years post- disaster. AIM 2 : Quantify the association between the characteristics of a disaster and increases in the likelihood of hospitalization among survivors. AIM 3 : Test the hypothesis that increases in level of disability and likelihood of hospitalization after disasters are worse for those living in counties with higher levels of poverty. This proposa is specifically responsive to PA-11-265. This proposal is innovative because long-term effects of disasters, particularly for vulnerable older Americans, have been systematically neglected in previous research. It is significant because it will address the public health consequences of a relatively common but understudied exposure. Further, a key contribution of this R21 will be to evaluate the feasibility of the National Research Council conjecture that natural disasters can be studied as exogenous shocks to the environment, and that we can thereby test and elaborate usually endogenous mechanisms in the development of disability.

Public Health Relevance

Although natural disasters frequently occur in the United States, most of what we know about their impact is focused on the short-term emergency. This project will inform our national disaster response services, and other health care providers, with information about the long-term aftereffects of natural disasters, separate from their short-term damage. It will also help identify groups that may be particularly vulnerable to worse problems after a natural disaster, so that additional help can be targeted to them.